“The awkward fact with which US policy wrestles is that People flee the world’s Haitis for a combination of motives.

1. “The awkward fact with which US policy wrestles is that People flee the world’s Haitis for a combination of motives. All are deserving of some compassion but how much?” Newsweek, Dec. 4 1991 “Give me your tired, your poor, Your huddled masses yearning to breathe free, The wretched refuse of your teeming shore. Send these, the homeless, tempest-tossed, to me” Inscribed at base of Statue of Liberty, by Emma Lazarus

2. As you know in the developing world treatable infectious diseases remain big killers Leading causes of death in Sub-Saharan Africa, South Asia, and Southeast Asia for persons age 0-44 (World Health Organization)

3. Now it’s time to look at number 3: Malaria Leading causes of death in Sub-Saharan Africa, South Asia, and Southeast Asia for persons age 0-44 (World Health Organization)

4. That’s right: 300 million new cases per year making it the most prevalent serious infectious disease! Leading causes of death in Sub-Saharan Africa, South Asia, and Southeast Asia for persons age 0-44 (World Health Organization)

5. 2.1 billion people live in MALARIOUS areas

6. Like HIV and TB, malaria is • unequally distributed, even in the tropics

7. In areas of Africa with high transmission • there are 2700 deaths per day = 2 per minute www.columbia.edu/itc/hs/medical/pathophys/parasitology/2006/PAR-05Color .pdf

8. It’s especially hard on kids

9. It’s especially hard on kids 75% of the deaths are among African children

10. www.uhhg.org/mcrh/resources/video/malariappt.pdf

11. What Is malaria? • A mosquito-borne infectious disease caused by Protozoan parasites of the genus Plasmodium

12. What Is malaria? • Transmitted only by Anopheles Mosquitoes (>60 species!) Seattle Biomedical Research Institute

13. What Is malaria? • The Disease can be Acute or Chronic

14. Acute Symptoms • Classical features include cyclic symptoms • Cold stage: chills and shaking • Hot stage: fever, headache, vomiting, seizures in children • Sweating stage: weakness • Feel well for period of time, then cycle repeats itself www.uhhg.org/mcrh/resources/video/malariappt.pdf

15. In fact it is several different diseases

16. www.columbia.edu/itc/hs/medical/pathophys/parasitology/2006/PAR-05Color .pdf

17. Each disease has a distinct course

18. Each disease has a distinct course “Tertian Malaria” (P.falciparum, P.ovale and P.vivax) fever occurs every third day. “Quartan Malaria” (P. malariae) fever occurs every fourth day. www.uhhg.org/mcrh/resources/video/malariappt.pdf

19. Each disease has a distinct course P.ovale and P.vivax can cause chronic malaria, reappearing after months or years due to latent parasites in liver www.uhhg.org/mcrh/resources/video/malariappt.pdf

20. Each disease also has a distinct geographical distribution www.uhhg.org/mcrh/resources/video/malariappt.pdf

21. Each disease also has a distinct geographical distribution www.columbia.edu/itc/hs/medical/pathophys/parasitology/2006/PAR-05Color .pdf

22. Each disease also has a distinct geographical distribution www.columbia.edu/itc/hs/medical/pathophys/parasitology/2006/PAR-05Color .pdf

24. Malaria damages the bodyin a number of ways • Red blood cell destruction -> anemia • Waves of parasites bursting red blood cells Lead to classic cycles of fever and chills

25. Malaria damages the bodyin a number of ways • Changes adhesive properties of infected Red blood cells -> blocking blood vessels leading to Tissue hypoxia

26. Malaria damages the bodyin a number of ways • If this happens in brain it is cerebral malaria which is often fatal Blocking blood vessels can also cause kidney failure

27. Malaria damages the bodyin a number of ways In severe cases 20% of patients can die, even with the best care

28. DIAGNOSIS • Gold standard: Multiple thick and thin smears

31. Malaria is not currently a serious threat in the US • 1300 cases in US per year • Essentially all “imported” • Also transfusion related malaria www.uhhg.org/mcrh/resources/video/malariappt.pdf

32. Although…. www.columbia.edu/itc/hs/medical/pathophys/parasitology/2006/PAR-05Color .pdf

33. Malaria is not currently a serious threat in the US

34. However, this was not always the case

35. Not that long ago…. www.columbia.edu/itc/hs/medical/pathophys/parasitology/2006/PAR-05Color .pdf

37. It could come back! www.columbia.edu/itc/hs/medical/pathophys/parasitology/2006/PAR-05Color .pdf

38. Let step back and lookat the parasites that cause malaria

39. It was discovered more than 100 years ago A French army doctor in Algeria observed parasites inside red blood cells of malaria patients and proposed for the first time that a protozoan caused disease Charles Louis Alphonse Laveran www.uhhg.org/mcrh/resources/video/malariappt.pdf

40. 1907 Nobel Prize for Physiology or Medicine! French army doctor in Algeria observed parasites inside red blood cells of malaria patients and proposed for the first time that a protozoan caused disease Charles Louis Alphonse Laveran www.uhhg.org/mcrh/resources/video/malariappt.pdf

41. So just who is this Plasmodium? www.columbia.edu/itc/hs/medical/pathophys/parasitology/2006/PAR-05Color .pdf

42. It’s not a bacterium or virus but a eukaryote like us www.columbia.edu/itc/hs/medical/pathophys/parasitology/2006/PAR-05Color .pdf

43. However, unlike us it lives a solitary life as a single cell www.columbia.edu/itc/hs/medical/pathophys/parasitology/2006/PAR-05Color .pdf

44. Let’s go back to the family tree

45. Let’s go back to the family tree http://drnelson.utmem.edu/Woods.Hole/slide5.png

46. Let’s go back to the family tree You and me http://drnelson.utmem.edu/Woods.Hole/slide5.png

47. mushrooms You and me http://drnelson.utmem.edu/Woods.Hole/slide5.png

48. mushrooms You and me plants http://drnelson.utmem.edu/Woods.Hole/slide5.png

49. We are family…. mushrooms You and me Plasmodium plants http://drnelson.utmem.edu/Woods.Hole/slide5.png

50. They are on the same region of the eukaryote tree as plants You and me Plasmodium plants http://drnelson.utmem.edu/Woods.Hole/slide5.png